Circulation Management

in Intoxication
Putu Anggia Dimitri Pramesti
1770121078
SGD 3

Block 4.5 Surgery

Program Studi Pendidikan Dokter
Fakultas Kedokteran dan Ilmu Kesehatan Universitas Warmadewa
2021
Article
Glucose-insulin-
potassium infusion for
the treatment of acute
aluminum phosphide
poisoning: an open-
label pilot study
 Introduction

Agriculture Pesticides

Aluminum
Aluminum
phosphide
phosphide
poisoning

No antidote
High case
currently
fatality rate
available
 Aluminum Phosphide Poisoning
1. Aluminum phosphide releases gas after exposure to moisture

2. Reaction is enhanced in the stomach by hydrochloric acid

3. Absorbed in GI and respiratory tract

4. Inhibits cytochrome C oxidase

5. Cellular hypoxia

6. Gastrointestinal disorder (garlic breath smell) , circulatory

shock, dysrhythmias, and respiratory failure (pulmonary edema)
 Poisoning Management
• Supportive : vasopressors and mechanical ventilation

• Very high case fatality rate (CFR) ranging from 30–80%,

mostly within 24–48 h

• Glucose-insulin-potassium infusion
 Glucose-insulin-potassium infusion

• Low case fatality rate (46,7%)

• Improvements in blood pressure (systolic, diastolic, mean arterial

pressure)

• Improvement in GCS at 12 hours

• Prolongs survival beyond 48 hours

• GIK maximizes myocardial glucose uptake, promotes energy

production from carbohydrates, and restores calcium flux

• Good cardiodynamic and hemodynamic response

 Summary
• GIK paired with supportive therapy showed a survival
benefit for the management of aluminum phosphide
poisoning

• Further study must be done

References
A. K. Pannu, A. Bhalla, J. Gantala,
N. Sharma, S. Kumar & D. P.
Dhibar (2020): Glucose-insulin-
potassium infusion for the treatment
of acute aluminum phosphide
poisoning: an open-label pilot study,
Clinical Toxicology, DOI:
10.1080/15563650.2020.1719131
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